Primary Disease Name: Arthritis
What is Arthritis?
Arthritis is one of the most pervasive diseases in the United
States and is the leading cause of disability. According to the
Centers for Disease Control and Prevention one out of every three
Americans (an estimated 70 million people) is affected by one of the
more than 100 types of arthritis.
For most people arthritis
pain and inflammation cannot be avoided as the body ages. In fact,
most people over the age of 50 show some signs of arthritis. Joints
naturally degenerate over time. Fortunately, arthritis can be
managed through a combination of medication, exercise, rest,
weight-management, nutrition, and, in some cases, surgery. Your
doctor can tell if you have arthritis through blood tests and
x-rays. He or she will then be able to help you decide on the best
treatment for your case.
Arthritis is a chronic disease that
will be with you for a long time and possibly for the rest of your
life. Your treatments will probably change over time and medication
may be adjusted. Having a positive mental outlook and the support of
family and friends will help you live with arthritis and be able to
continue to perform your daily activities.
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What is Osteoarthritis ?
Osteoarthritis is the most common form of arthritis in the United
States, affecting more than 20 million Americans. Osteoarthritis
(OA) begins with the breakdown of cartilage in joints, resulting in
joint pain and stiffness.
Osteoarthritis commonly affects
the joints of the fingers, knees, hips, and spine. Other joints
affected less frequently include the wrists, elbows, shoulders, and
ankles. When Osteoarthritis is found in one of these joints, there
is usually a history of injury or unusual stress.4,5
If you
think you might have Osteoarthritis, take the time to learn more
about its symptoms, causes, and diagnosis. Make an appointment to
see your doctor. Only your doctor can diagnose your condition. Early
diagnosis is important so you can begin treatment that will help to
relieve pain, improve mobility, and minimize disability.5 The more
you know about Osteoarthritis and its treatments, the more you can
do to minimize the inflammation and the pain it can cause.
Causes of Osteoarthritis
Osteoarthritis used to be seen only as an older persons disease.
Now, because of the modern stresses in our lives, people of all ages
suffer from the aches and pains associated with
osteoarthritis.
General wear and tear on the joints can cause
osteoarthritis. However, playing sports such as jogging, tennis and
skiing are also potential instigators of the disease. If your
occupation entails heavy lifting or excessive use of your hands, you
may be at a greater risk of developing osteoarthritis.
There
is no known cause of osteoarthritis. A specific joint injury or
other joint disease like rheumatoid arthritis may cause
osteoarthritis. Gout and congenital defects to the joint are
secondary causes of osteoarthritis. Hypermobiles, or people that are
extremely flexible, are also more prone to the disease.
Some
recent studies have pointed to genetics as a possible cause. It
could be possible that some cartilage is more likely to degenerate
than others. Chemical reactions in your body could also lead to the
breakdown of cartilage, various experts believe (The Arthritis
Bible, Healing Arts Press, 1999). At this time researchers are
trying to develop a test that will detect the breakdown of
cartilage. As with most types of arthritis, being overweight also
plays a role because of the added pressure on the body.
Symptoms of Osteoarthritis
The most common symptoms are pain and stiffness in the joint.
Early on in the disease, pain may only be felt after exercise, but
will go away after you rest. Over time, the occasional pain may
become constant and wake you up at night. The cartilage may continue
to wear away until bone is crunching on bone and a grating sound is
heard.
In the long term, loss of mobility may occur. The
joint may feel warm to the touch and may be swollen. This is called
erosive inflammatory osteoarthritis. Deformity may result when one
side of the joint collapses more than the other side. However, most
people do not become crippled as a result of osteoarthritis.
If you suspect you have osteoarthritis, visit your doctor.
He or she will perform a series of tests to determine if you have
arthritis and what type. X-rays may be ordered to see if the bone
and cartilage have been damaged. Blood tests may be ordered to rule
out other types of disease.
The outlook for the disease
depends mainly on which joints are affected and how serious it is.
There are many forms of treatment and, by starting early, you can
start to live your life more fully.
Treatment of Osteoarthritis
The good news is that osteoarthritis does not need to get worse
over time. At this time, there is no known cure for osteoarthritis.
However, there are treatments that help decrease the arthritis pain
you are feeling and help you regain mobility.
Exercise,
weight loss, rest and proper nutrition are very helpful in treating
this disease. Through exercise, you can regain strength and manage
your body weight. Proper nutrition and rest will make sure you feel
your best. It is important to discuss any exercise program with your
doctor or physical therapist before starting one. You should also
talk with your doctor before taking alternative medicines, food
supplements, and herbal medicines to treat your
arthritis.
There are many assistive devices designed to make
your life easier. Opening car doors and cans and bottles is made
easier through new inventions. The old-fashioned cane can help you
continue to walk and to get your exercise. Some people find that
using heat or cold applications or paraffin baths help relieve pain
and regain joint mobility.
Arthritis pain relief may be
found in taking aspirin or acetaminophen. These drugs are called
nonsteroidal anti-inflammatory drugs (NSAIDs). By discussing your
pain with your doctor, he or she will be able to tell you which type
of drugs will work best for you.
There are several types of
surgical treatments available. Surgery may be an option if you are
suffering from osteoarthritis of the hip, knee, back, shoulder, hand
or foot. Joint replacement techniques have advanced in the last 25
years making this surgery more common. Your doctor will help you
make this serious decision based on the level of your pain, job and
age.
Learning that you have osteoarthritis, does not have to
mean an end to your active lifestyle. Your physician can help you
find the most effective treatment for managing your osteoarthritis
and controlling your arthritis pain.
What is Rheumatoid Arthritis
Rheumatoid arthritis (RA) involves inflammation of the lining of
many different joints in your body. In some people, Rheumatoid
arthritis can also affect other parts of the body, including the
blood, the lungs, and the heart. Inflammation of the joint lining,
called the synovium, can cause pain, stiffness, swelling, warmth,
and redness. The affected joint may also lose its shape, resulting
in loss of normal movement. Rheumatoid arthritis can last a long
time, and can be a disease of flares (active) and remissions (little
to no activity).
View our animation to see how inflammation
and joint damage progress in rheumatoid arthritis.
Rheumatoid arthritis affects about 2.1 million Americans, or
about 1% of the adult population in the United States. This disease
is two to three times more common in women than in men, and
generally affects people between the ages of 20 and 50. However,
young children can develop a form of Rheumatoid arthritis called
juvenile rheumatoid arthritis.
If you think you might have
Rheumatoid arthritis, you may want to learn more about its symptoms,
causes, and diagnosis. Make an appointment to see your doctor. Only
your doctor can determine if you have Rheumatoid arthritis. An early
diagnosis can lead to a more successful treatment and help control
the progression of Rheumatoid arthritis.
Causes of Rheumatoid Arthritis
The exact cause of rheumatoid arthritis is unknown. Many doctors
believe that a virus or a bacterium may prompt rheumatoid arthritis
to develop in those people who have a genetic predisposition to it.
Seven out of ten people who have rheumatoid arthritis have an
inherited chemical marker on their cells leading doctors to believe
that there is a correlation.
Some experts think rheumatoid
arthritis is an autoimmune disease, meaning that the body tissue is
the victim of an immune response against itself. The body creates
antibodies that actually attack the joints causing the swelling and
redness. Excess fluid will flow into the joint space making joint
motion painful.
Severe stress may also play a role. In some
cases, rheumatoid arthritis will first appear after a person has
experienced a life-changing event like a divorce, loss of a job,
death of a loved one or a severe injury.
Symptoms of Rheumatoid Arthritis
In many cases, rheumatoid arthritis develops gradually and can
come and go over the years. About half of all people with this
disease will have a remission within two years. However, the
symptoms can return, as there is no permanent cure for rheumatoid
arthritis. If you developed rheumatoid arthritis after 60 years of
age, you have a greater chance of having a milder case than someone
who developed the disease when younger.
The joint lining,
called the synovium, becomes inflamed in cases of rheumatoid
arthritis, leading to pain, stiffness, warmth, redness and swelling.
These inflamed cells release an enzyme that may even digest
cartilage and bone. It is important to start a course of treatment
so that you can continue to live your life the way you want.
Other symptoms of rheumatoid arthritis include:
Fatigue and/or weakness
Stiffness following periods of
immobility which gradually improves with movement
Rheumatoid
nodules (lumps of inflamed cells) under the skin usually found on
the bony part of the forearm, ankle and fingers
Minor fevers,
anemia, weight loss
Treatment of Rheumatoid Arthritis
If your doctor suspects that you have rheumatoid arthritis, he or
she will order a series of diagnostic tests after performing a
physical examination. One test he or she may order looks for an
antibody called rheumatoid factor. Approximately 85 percent of
people with rheumatoid arthritis have this antibody.
Once a
diagnosis is made, you can start a series of treatments designed to
help you continue to live your life. Advances in treatment have been
made so that few people with rheumatoid arthritis end up bed ridden.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
aspirin and ibuprofen are used to reduce pain and swelling in the
short term. Disease modifying drugs (DMARDs) may also be used if you
dont respond to NSAID treatment. These slow acting drugs are
designed to help slow the progression of rheumatoid arthritis. Over
the long term, biologic response modifiers may be used. These drugs
are either injected or given intravenously. Corticosteroid
medications, like Prednisone, may also be used to help you during
flareups.
Exercise is one of the best things you can do for
your arthritis. It will increase your strength and give you
endurance. Stretching will help your joints retain or gain
flexibility. Exercise not only helps your body but also will improve
your state of mind. Remember that there are many ways to exercise.
Speak to your doctor before starting an exercise program.
In
some cases, surgery may be necessary. Surgery, such as joint
replacement, is considered when you and your doctor have concluded
that previous treatments for pain and mobility have been
unsuccessful and your quality of life is suffering. In addition to
joint replacement surgery, other types of surgery include the
reconstruction or fusion of a joint and the removal of diseased
tissue from the joint (synovectomy).
Treating Arthritis
Traditional NSAIDs
Traditional
nonsteroidal anti-inflammatory drugs (NSAIDs) are used for the
treatment of both rheumatoid arthritis and osteoarthritis. Aspirin
was the first member of this class of drugs. Many newer agents have
been developed; some are available by prescription only, and some
are available without a prescription (over-the-counter).
Traditional NSAIDs have four fundamental actions in the
body. They act to:
Reduce inflammation
Relieve pain
Lower fever
Prevent blood clotting
NSAIDs
produce these effects because they inhibit an enzyme called
cyclooxygenase (COX), which is present in two forms in the body. The
COX-1 enzyme performs many important normal functions, including
protecting the stomach from harsh acid and digestive chemicals. A
different form of this enzyme, COX-2, is not normally found in the
body at high levels. It is produced when joints are injured or
inflamed. It is COX-2 that contributes to the pain and inflammation
of arthritis. Traditional NSAIDs block both forms of the enzyme,
while certain medicines block only the inflammation-producing COX-2
enzyme.
COX 2 specific inhibitors
COX-2
specific inhibitors have advanced arthritis treatment. These drugs
selectively block the inflammation-producing COX-2 specific enzyme
that is produced in arthritic joints. Unlike traditional NSAIDs,
COX-2 specific inhibitors do not affect the COX-1 enzyme, which is
important for maintaining a healthy stomach lining, normal kidney
function, and the clotting action of blood
platelets.
Currently, there are three COX-2 specific
inhibitors available: Bextra(valdecoxib tablets), CELEBREX
(celecoxib capsules), and Vioxx (rofecoxib). All three of these
medicines are used to treat the pain and inflammation of
osteoarthritis and rheumatoid arthritis. 10,57 In rare cases,
serious stomach problems such as bleeding can occur without warning
in patients taking COX-2 specific inhibitors.
DMARDs: Prescription Rheumatoid Arthritis
Medications
A class of medicines called disease-modifying antirheumatic drugs
are frequently referred to as DMARDs.
According to Arthritis
& Rheumatism, the official journal of the American College of
Rheumatology, DMARDs have the potential to reduce or prevent joint
damage and preserve joint integrity and function.
The goal of
DMARDs is the remission or control of inflammatory joint disease,
like rheumatoid arthritis. While other arthritis medicines attack
symptoms, such as inflammation, DMARDs actually treat the disease.
DMARDs affect the immune system. In patients with rheumatoid
arthritis, the immune system attacks the joint lining, resulting in
inflammation that can lead to destruction of the surrounding joint.
Researchers are still seeking a better understanding of exactly how
DMARDs work. DMARDs are intended to reduce or prevent joint damage,
preserve joint function, and maintain patient mobility.
DMARDs are relatively slow acting, with a delay of one to
six months before they begin to show results. Effectiveness cannot
be predicted for the individual patient, but up to two-thirds of
patients may have a response to these agents. Each DMARD has
specific toxicity or side effects that require careful monitoring.
Timing is critical. In the past, many physicians often used
DMARDs only after other treatments had been tried. That has changed
in recent years. Today, physicians are just as likely to use DMARDs
immediately after diagnosing a case of rheumatoid arthritis. Thats
because these drugs have the potential to actually halt or reduce
the progression of the disease before joints are further damaged.
A few commonly prescribed DMARDs include:
leflunomide
azathioprine
hydroxychloroquine sulfate
methotrexate
penicillamine
sulfasalazine
cyclosporine
These drugs are used primarily to treat
rheumatoid arthritis, and some are also used for other
arthritis-related diseases, including lupus, psoriatic arthritis and
ankylosing spondylitis.
Combinations of DMARDs are often used
together, because each drug in the combination can be used in
smaller dosages than if it were given alone, thus reducing the risk
of side effects.
Many patients receive an NSAID and at least
one DMARD, sometimes with low-dose oral glucocorticoids. If disease
remission is observed, regular NSAIDs or glucocorticoid treatment
may no longer be needed. DMARDs help control arthritis but do not
cure the disease. For that reason, if remission or optimal control
is achieved with a DMARD, it often is continued at a maintenance
dosage. Discontinuing a DMARD may reactivate disease or cause a
rebound flare, with no assurance that disease control will be
reestablished upon resumption of the medication, according to
Arthritis & Rheumatism.
For women of childbearing age,
effective contraception is required when most DMARDs are prescribed.
The drug regimen will need modification if the patient wishes to
become pregnant, or if breastfeeding is contemplated.
Many
factors influence the choice of a DMARD for an individual patient.
From the patient's perspective, the convenience of administration of
the drug, the requirements of the monitoring program, the costs of
the medication and its monitoring, the time until expected benefit,
and the frequency and potential seriousness of adverse reactions are
important considerations.
DMARDs are powerful drugs and can
cause a wide range of side effects, from serious stomach problems
and diarrhea, loss of appetite, hair loss, and many other reactions.
DMARDS affect the immune system; consequently some, like
cyclosporine, can make you more prone to infections. Some can cause
birth defects if taken by women who are pregnant or may become
pregnant. These are just a few of the potentially serious
implications of using this powerful class of drugs. Your physician
will discuss the benefits and potential adverse effects with
you.
Some DMARDs require ongoing monitoring to reduce adverse
effects on the liver, kidney or other organs. For example, if you
take the DMARD methotrexate, liver tests and blood counts are used
at the outset and throughout your treatment, on a regular schedule
set by your physician. Other DMARDs will also require periodic
ongoing medical tests (blood samples, urine tests) to monitor your
bodys response to the
New Osteoarthritis Treatments
Over the past several years, the FDA approved a group of
medications called viscosupplements. They are injected directly into
the joint. They include:
Hyalgan
Supartz
Synvisc
Neovisc
Viscosupplements can help reduce the pain in a knee
affected by osteoarthritis, increasing mobility and allowing more
activity.
How Do They Work?
Normal
joint fluid contains a substance called hyaluronan. It acts like a
shock absorber and lubricant in your joint and is needed to help the
joint work properly. Hyaluronan is highly viscous, allowing the
cartilage surfaces of the bones to glide upon each other smoothly.
What Joints Can Be Treated With These Drugs?
Currently, these drugs are only approved for treatment
of mild to moderate knee arthritis.
Candidates for
These Treatments
These drugs are used to treat
osteoarthritis pain in the knee in people who have not found
significant relief of their symptoms from:
Physical therapy
Exercise
Heat or cold
Over-the-counter pain
relievers
These drugs can be injected into both knees or just a
single knee joint.
Side Effects
Potential side effects include pain, heat, or redness at the
injection site. They can't be taken by people with skin or joint
infections or people with egg allergies.
What to
Expect From Treatment
Hyalgan is administered in five
weekly injections, Synvisc in three. Pain relief is usually obtained
by eight to 12 weeks after the first injection and can last up to
six months.
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